PURPOSE: To describe the outcomes of patients with low-risk localized prostate cancer who upgraded on a surveillance biopsy while on AS, and to evaluate whether delayed treatment was associated with adverse outcome.
MATERIALS AND METHODS: We included men with lower risk disease managed initially with AS, and upgraded to Gleason score ≥3+4. Patients' demographics and disease characteristics were compared. Kaplan-Meier curve was used to estimate the treatment-free probability stratified by initial upgrade (3+4 vs ≥4+3), Cox regression analysis to examine factors associated with treatment, and multivariate logistic regression analysis to evaluate the factors associated with adverse outcome at surgery.
RESULTS: The final cohort comprised 219 men, 150 (68%) upgraded to 3+4 and 69 (32%) to ≥4+3. Median time to upgrade was 23 months (IQR 11-49). 163 men (74%) sought treatment, the majority (69%) with radical prostatectomy (RP). The treatment-free survival at 5 years was 22% for 3+4 and 10% for ≥4+3 upgrade. Upgrade to ≥4+3, higher PSA density (PSAD) at diagnosis, and shorter time to initial upgrade were associated with treatment. At surgical pathology, 34% of cancers were downgraded while 6% were upgraded. Cancer volume at initial upgrade was associated with adverse pathological outcome at surgery (OR 3.33, 95% CI 1.19-9.29, p=0.02).
CONCLUSION: Following Gleason score upgrade, most patients elected treatment with RP. Among men who deferred definitive intervention, very few experienced additional upgrading. At RP, only 6% of men were upgraded further, and only tumor volume at initial upgrade was significantly associated with adverse pathological outcome.
Hussein AA, Welty CJ, Ameli N, Cowan JE, Leapman M, Porten SP, Shinohara K, Carroll PR. Are you the author?
Department of Urology and UCSF - Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco; Department of Urology, Cairo University, Egypt.
Reference: J Urol. 2015 Jan 23. pii: S0022-5347(15)00167-6.